POS0598 PERSISTING PAIN IN RHEUMATOID ARTHRITIS: DO WE NEED TO RECONSIDER OUR IDEA OF PAIN ALLEVIATION DESPITE ANTI-INFLAMMATORY TREATMENT?
Authors: C. Baerwald, E. Stemmler, S. Gnuechtel, K. Jeromin, C. Holland, B. Fritz, D. Adolf, P. C. Taylor, R. Baron
Journal: Annals of the Rheumatic Diseases (2022)

Background Pain significantly impacts life of patients with rheumatoid arthritis (RA) (1). Besides articular pain due to systemic inflammation, neuropathic pain (NeP) represents another challenge that can pose a considerable burden on the life of patients (2). Objectives To investigate persisting pain in RA patients and to analyse NeP along with patient-reported outcomes (PROs). Methods PAIN-CONTROL is a prospective, non-interventional study in rheumatology centres in Germany. Inclusion criteria were fulfilment of the 2010 ACR/EULAR RA classification criteria, disease duration ≤ 8 yrs, DAS28 &gt; 3.2, SJC &gt; 3, CRP normal or above reference range, and pain rating ≥ 50 (0-100 VAS). Eligible subjects had to be scheduled for escalation of anti-inflammatory treatment according to national guidelines. At wk 24 subjects were allocated to three subgroups given DAS28-CRP change and VAS pain: i) reference group: VAS pain &lt; 50 with either DAS28 improvement &gt; 1.2 or DAS28 ≤ 3.2, ii) non-responders: DAS28 improvement ≤ 1.2 and DAS28 &gt; 3.2 with or without pain alleviation, iii) persisting pain: VAS pain ≥ 50 with either DAS28 improvement &gt; 1.2 or DAS28 ≤ 3.2. For groups 1 and 2 end of study was at week 24, patients with persisting pain continued until wk 48. Patients were assessed for NeP using a score of ≥ 19 in the painDETECT questionnaire (PD-Q) (3). Pain-related PROs, i.e. the Rheumatoid Arthritis Impact of Disease Questionnaire (RAID) and the Patient Health Questionnaire (PHQ-9), were analysed along with demographic background information (1,4). Descriptive results are presented as mean (SD) or mean (SD) | N valid , as well as n (%) or n (%) | N valid , respectively. Results 567 subjects were analysed with the following distribution: Reference group 337 (59.4%), non-responders 102 (18.0%), and persisting pain 128 (22.6%), of which 115 patients were available at wk 48. Subgroups showed similar demographic baseline characteristics but differed in PROs (Table 1). Until wk 24, proportion of patients with NeP indication decreased in the reference group (-19.8%) and slightly in non-responders (-6.0%) and persisting pain group (-9.5%). Non-responders showed the highest NeP proportion at wk 24 (35.0%) (Table 1). Of 115 patients with persisting pain at wk 24, 47 (40.9%) tested NeP negative at wk 48, 21 (18.3%) tested unclear, 28 (24.3%) were missing and 19 (16.5%) tested positive. Of the latter 9 patients (47.4%) still had persisting pain at week 48, while this was the case for 14 patients (29.8%) in the former group. 49 (42.6%) of 115 patients with severe persisting pain at wk 24 reported pain alleviation at wk 48 and fulfillment of reference group criteria. RAID and PHQ-9 scores improved in the reference group but only slightly in the other two subgroups. Table 1. Demographic background and PROs Characteristic Reference group(N = 337) Non-responders(N = 102) Persisting pain(N = 128) Gender (f/m) 233 (69.1%) / 65 (63.7%) / 87 (68.0%) / 104 (30.9%) 37 (36.3%) 41 (32.0%) Age 57.1 (13.2) | 337 59.9 (12.0) | 102 57.1 (13.0) | 128 Disease duration (yrs) 2.5 (2.6) | 337 2.7 (2.8) | 102 2.5 (2.5) | 128 PD-Q (≥ 19) (Bl) 82 (28.6%) | 287 32 (41.0%) | 78 40 (36.0%) | 111 PD-Q (≥ 19) (wk 24) 21 (8.8%) | 239 28 (35.0%) | 80 27 (26.5%) | 102 PD-Q (Bl) 14.0 (6.8) | 287 15.5 (7.1) | 78 15.5 (6.5) | 111 PD-Q (wk 24) 8.8 (5.8) | 239 14.8 (6.7) | 80 13.8 (7.2) | 102 RAID (Bl) 5.8 (2.0) | 332 6.0 (1.9) | 100 6.6 (1.7) | 125 RAID (wk 24) 2.4 (1.8) | 321 5.4 (1.9) | 97 5.1 (1.9) | 123 PHQ-9 (Bl) 7.3 (5.1) | 328 8.4 (5.4) | 98 7.9 (5.1) | 123 PHQ-9 (wk 24) 3.8 (3.5) | 318 7.3 (4.5) | 95 6.6 (4.5) | 122 Conclusion NeP is common among RA non-responders to anti-inflammatory treatment and in patients with persisting pain, meriting a routine NeP screening to more adequately address persisting pain in these patients. However, even late improvements (after 24 wks) regarding persisting pain seem likely during anti-inflammatory treatment. References [1]Gossec L, Ann Rheum Dis. 2011 Jun;70(6):935–42. [2]Noda K, Mod Rheumatol. 2020 Sep;30(5):828–34. [3]Freynhagen R, Curr Med Res Opin. 2006 Oct;22(10):1911–20. [4]Kroenke K, J Gen Intern Med. 2001 Sep;16(9):606–13. Acknowledgements Statistical analysis was provided under lead of Dr. Daniela Adolf of StatConsult GmbH, which was funded by AbbVie. Medical writing support was provided by Dr. Matthias Englbrecht of Statscoach, which was funded by AbbVie. Disclosure of Interests Christoph Baerwald Speakers bureau: Prof. Christoph G. Baerwald has served as consultant to AbbVie and has received research funding and speaker fees from AbbVie., Consultant of: Prof. Christoph G. Baerwald has served as consultant to AbbVie and has received research funding and speaker fees from AbbVie., Grant/research support from: Prof. Christoph G. Baerwald has served as consultant to AbbVie and has received research funding and speaker fees from AbbVie., Edgar Stemmler Shareholder of: Dr. Edgar Stemmler is employee of AbbVie and may own AbbVie stock., Employee of: Dr. Edgar Stemmler is employee of AbbVie and may own AbbVie stock., Sixten Gnuechtel Shareholder of: Dr. Sixten Gnüchtel is employee of AbbVie and may own AbbVie stock., Employee of: Dr. Sixten Gnüchtel is employee of AbbVie and may own AbbVie stock., Katharina Jeromin Shareholder of: Dr. Katharina Jeromin is employee of AbbVie and may own AbbVie stock, Employee of: Dr. Katharina Jeromin is employee of AbbVie and may own AbbVie stock, Carsten Holland Shareholder of: Dr. Carsten Holland is employee of AbbVie and may own AbbVie stock, Employee of: Dr. Carsten Holland is employee of AbbVie and may own AbbVie stock, björn fritz Shareholder of: Dr. Björn Fritz is employee of AbbVie and may own AbbVie stock., Employee of: Dr. Björn Fritz is employee of AbbVie and may own AbbVie stock., Daniela Adolf Consultant of: Dr. Daniela Adolf is an employee of StatConsult GmbH. Statistical analysis was provided under lead of Dr. Daniela Adolf of StatConsult GmbH, which was funded by AbbVie, Peter C. Taylor Speakers bureau: Peter C. Taylor has served as consultant to AbbVie and has received speaker fees from AbbVie, Consultant of: Peter C. Taylor has served as consultant to AbbVie and has received speaker fees from AbbVie, Ralf Baron Speakers bureau: Prof. Ralf Baron has served as consultant to AbbVie and has received speaker fees from AbbVie., Consultant of: Prof. Ralf Baron has served as consultant to AbbVie and has received speaker fees from AbbVie.